Provider Demographics
NPI:1760861132
Name:LINDHOLM, WENDY JO
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JO
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:JO
Other - Last Name:GRAPENGIESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9130 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9784
Mailing Address - Country:US
Mailing Address - Phone:920-296-8664
Mailing Address - Fax:
Practice Address - Street 1:9130 N FULTON ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9784
Practice Address - Country:US
Practice Address - Phone:920-296-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse